A pulse oximetry monitoring system at Dartmouth-Hitchcock Medical Center, Lebanon, N.H., has greatly reduced the need for rapid response teams for post-surgical patients suffering from adverse events.

The round-the-clock system tracks blood oxygen saturation levels and heart rate, and automatically alerts the nurse via pager when preset thresholds are met. To reduce alarm fatigue, the thresholds are set to identify situations that require intervention based on patient need, and the pager notification is activated only after the threshold has been met for more than 30 seconds.

On the orthopedic unit, the number of rescue events (defined as situations requiring activation of a rapid response team) fell from 3.4 to 1.2 per 1,000 patient days in the 10 months after implementation. The number of transfers to the ICU among patients on the orthopedic unit fell from 5.6 before implementation to 2.9 per 1,000 patient days afterward.

The decline translates into roughly 150 fewer days spent in ICU beds. Less significant declines occurred in the two comparison units that did not implement the program—from 5.7 to 5.2 ICU transfers per 1,000 patient days on the general surgical unit and from 15.0 to 12.7 ICU transfers per 1,000 patient days on the specialty unit.


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